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Gervasoni S, Pedrini N, Rifai T, Fischer C, Landers FC, Mattmann M, Dreyfus R, Viviani S, Veciana A, Masina E, Aktas B, Puigmartí-Luis J, Chautems C, Pané S, Boehler Q, Gruber P, Nelson BJ. A Human-Scale Clinically Ready Electromagnetic Navigation System for Magnetically Responsive Biomaterials and Medical Devices. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2024:e2310701. [PMID: 38733269 DOI: 10.1002/adma.202310701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 04/15/2024] [Indexed: 05/13/2024]
Abstract
Magnetic navigation systems are used to precisely manipulate magnetically responsive materials enabling the realization of new minimally invasive procedures using magnetic medical devices. Their widespread applicability has been constrained by high infrastructure demands and costs. The study reports on a portable electromagnetic navigation system, the Navion, which is capable of generating a large magnetic field over a large workspace. The system is easy to install in hospital operating rooms and transportable through health care facilities, aiding in the widespread adoption of magnetically responsive medical devices. First, the design and implementation approach for the system are introduced and its performance is characterized. Next, in vitro navigation of different microrobot structures is demonstrated using magnetic field gradients and rotating magnetic fields. Spherical permanent magnets, electroplated cylindrical microrobots, microparticle swarms, and magnetic composite bacteria-inspired helical structures are investigated. The navigation of magnetic catheters is also demonstrated in two challenging endovascular tasks: 1) an angiography procedure and 2) deep navigation within the circle of Willis. Catheter navigation is demonstrated in a porcine model in vivo to perform an angiography under magnetic guidance.
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Affiliation(s)
- Simone Gervasoni
- Multi-Scale Robotics Lab, ETH Zurich, CH-8092, Zurich, Switzerland
| | - Norman Pedrini
- Multi-Scale Robotics Lab, ETH Zurich, CH-8092, Zurich, Switzerland
| | - Tarik Rifai
- Multi-Scale Robotics Lab, ETH Zurich, CH-8092, Zurich, Switzerland
| | - Cedric Fischer
- Multi-Scale Robotics Lab, ETH Zurich, CH-8092, Zurich, Switzerland
| | - Fabian C Landers
- Multi-Scale Robotics Lab, ETH Zurich, CH-8092, Zurich, Switzerland
| | - Michael Mattmann
- Multi-Scale Robotics Lab, ETH Zurich, CH-8092, Zurich, Switzerland
| | - Roland Dreyfus
- Multi-Scale Robotics Lab, ETH Zurich, CH-8092, Zurich, Switzerland
| | - Silvia Viviani
- Multi-Scale Robotics Lab, ETH Zurich, CH-8092, Zurich, Switzerland
| | - Andrea Veciana
- Multi-Scale Robotics Lab, ETH Zurich, CH-8092, Zurich, Switzerland
| | - Enea Masina
- Multi-Scale Robotics Lab, ETH Zurich, CH-8092, Zurich, Switzerland
| | - Buse Aktas
- Multi-Scale Robotics Lab, ETH Zurich, CH-8092, Zurich, Switzerland
| | - Josep Puigmartí-Luis
- Departament de Ciència dels Materials i Química Física, Institut de Química Teòrica i Computacional, University of Barcelona (UB), 08028, Barcelona, Spain
- Institució Catalana de Recerca i Estudis Avançats (ICREA), Pg. Lluís Companys 23, 08010, Barcelona, Spain
| | | | - Salvador Pané
- Multi-Scale Robotics Lab, ETH Zurich, CH-8092, Zurich, Switzerland
| | - Quentin Boehler
- Multi-Scale Robotics Lab, ETH Zurich, CH-8092, Zurich, Switzerland
| | - Philipp Gruber
- Kantonsspital Aarau AG, Tellstrasse 25, CH-5001, Aarau, Switzerland
| | - Bradley J Nelson
- Multi-Scale Robotics Lab, ETH Zurich, CH-8092, Zurich, Switzerland
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Luke K, Milla C, Tandi JK, Julario R. Zero to minimal fluoroscopy for cardiac electronic device implantation: A systematic review and meta-analysis. J Arrhythm 2024; 40:38-46. [PMID: 38333407 PMCID: PMC10848632 DOI: 10.1002/joa3.12949] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 10/11/2023] [Accepted: 10/17/2023] [Indexed: 02/10/2024] Open
Abstract
Background Fluoroscopy is conventionally performed for cardiac implantable electronic device (CIED) therapy and carries radiation drawback for both patients and medical workers. Recently, zero to minimal fluoroscopy (ZMF) approach is introduced to reduce radiation exposure of fluoroscopy. This study compares the feasibility and safety of ZMF approach to fluoroscopy for CIEDs therapy in adults. Method A systematic literature search was conducted on PubMed, ScienceDirect, and Web of Science in March 2023. All observational or experimental studies comparing ZMF approach to fluoroscopy for adult CIEDs therapy were included. Reviews, case report/series, animal studies, and non-English articles were excluded. The success rate, procedural time, fluoroscopy time, radiation dose, and complications rate were compared for each approach. Results Seven articles for permanent and three articles for temporary CIEDs were included for analysis. The success rate of ZMF for permanent CIEDs was similar to fluoroscopy method (OR: 0.77, 95% CI: 0.33-4.15). The procedural time of ZMF was similar to fluoroscopy for both permanent and temporary CIEDs (standardized mean difference [SMD]: 0.10, 95% CI: -0.35 to 0.55 and SMD: -0.71, 95% CI: -1.87-0.44, respectively). However, ZMF approach markedly reduced the fluoroscopy time and radiation exposure for permanent CIEDs (SMD: -1.80, 95% CI: -2.49 to -1.12 and SMD: -1.26, 95% CI: -2.24 to -0.29). The complication rate was similar for permanent CIEDs (OR: 1.08, 95% CI: 0.41-2.84), yet lowered for temporary CIEDs (OR: 0.34, 95% CI: 0.20-0.59). Conclusion ZMF had similar success rate, procedural time, and sum complication rate for permanent CIEDs implantation with a significant reduction of fluoroscopy time and radiation exposure.
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Affiliation(s)
- Kevin Luke
- Faculty of MedicineUniversitas AirlanggaSurabayaIndonesia
| | - Clonia Milla
- Faculty of MedicineUniversitas AirlanggaSurabayaIndonesia
| | | | - Rerdin Julario
- Department of Cardiology and Vascular MedicineDr. Soetomo General Hospital‐Universitas AirlanggaSurabayaIndonesia
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Gubbi MR, Assis F, Chrispin J, Bell MAL. Deep learning in vivo catheter tip locations for photoacoustic-guided cardiac interventions. JOURNAL OF BIOMEDICAL OPTICS 2024; 29:S11505. [PMID: 38076439 PMCID: PMC10704189 DOI: 10.1117/1.jbo.29.s1.s11505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 09/27/2023] [Accepted: 10/23/2023] [Indexed: 12/18/2023]
Abstract
Significance Interventional cardiac procedures often require ionizing radiation to guide cardiac catheters to the heart. To reduce the associated risks of ionizing radiation, photoacoustic imaging can potentially be combined with robotic visual servoing, with initial demonstrations requiring segmentation of catheter tips. However, typical segmentation algorithms applied to conventional image formation methods are susceptible to problematic reflection artifacts, which compromise the required detectability and localization of the catheter tip. Aim We describe a convolutional neural network and the associated customizations required to successfully detect and localize in vivo photoacoustic signals from a catheter tip received by a phased array transducer, which is a common transducer for transthoracic cardiac imaging applications. Approach We trained a network with simulated photoacoustic channel data to identify point sources, which appropriately model photoacoustic signals from the tip of an optical fiber inserted in a cardiac catheter. The network was validated with an independent simulated dataset, then tested on data from the tips of cardiac catheters housing optical fibers and inserted into ex vivo and in vivo swine hearts. Results When validated with simulated data, the network achieved an F 1 score of 98.3% and Euclidean errors (mean ± one standard deviation) of 1.02 ± 0.84 mm for target depths of 20 to 100 mm. When tested on ex vivo and in vivo data, the network achieved F 1 scores as large as 100.0%. In addition, for target depths of 40 to 90 mm in the ex vivo and in vivo data, up to 86.7% of axial and 100.0% of lateral position errors were lower than the axial and lateral resolution, respectively, of the phased array transducer. Conclusions These results demonstrate the promise of the proposed method to identify photoacoustic sources in future interventional cardiology and cardiac electrophysiology applications.
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Affiliation(s)
- Mardava R. Gubbi
- Johns Hopkins University, Department of Electrical and Computer Engineering, Baltimore, Maryland, United States
| | - Fabrizio Assis
- Johns Hopkins Medical Institutions, Division of Cardiology, Baltimore, Maryland, United States
| | - Jonathan Chrispin
- Johns Hopkins Medical Institutions, Division of Cardiology, Baltimore, Maryland, United States
| | - Muyinatu A. Lediju Bell
- Johns Hopkins University, Department of Electrical and Computer Engineering, Baltimore, Maryland, United States
- Johns Hopkins University, Department of Biomedical Engineering, Baltimore, Maryland, United States
- Johns Hopkins University, Department of Computer Science, Baltimore, Maryland, United States
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Kim CL, Jeong HC, Kim JH. Radiation shielding effects of lead equivalent thickness of a radiation protective apron and distance during C-arm fluoroscopy-guided pain interventions: A randomized trial. Medicine (Baltimore) 2023; 102:e36447. [PMID: 38050291 PMCID: PMC10695529 DOI: 10.1097/md.0000000000036447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 11/13/2023] [Indexed: 12/06/2023] Open
Abstract
BACKGROUND The present study aimed to evaluate the degree of radiation shielding effects according to lead equivalent thickness and distance during C-arm fluoroscopy-guided lumbar interventions. METHODS The exposure time and air kerma were recorded using a fluoroscope. The effective dose (ED) was measured with and without the shielding material of the lead apron using 2 dosimeters at 2 positions. According to the lead equivalent thickness of the shielding material and distance from the side of the table, the groups were divided into 4 groups: group 1 (lead equivalent thickness 0.6 mm, distance 0 cm), group 2 (lead equivalent thickness 0.6 mm, distance 5 cm), group 3 (lead equivalent thickness 0.3 mm, distance 0 cm), and group 4 (lead equivalent thickness 0.3 mm, distance 5 cm). Mean differences such as air kerma, exposure time, ED, and ratio of EDs (ED with protector/ED without protector) were analyzed. RESULTS A total of 400 cases (100 cases in each group) were collected. The ratio of ED was significantly lower in groups 1 and 2 (9.18 ± 2.78% and 9.56 ± 3.29%, respectively) when compared to that of groups 3 and 4 (21.93 ± 4.19% and 21.53 ± 4.30%, respectively). The reductive effect of a 5-cm distance was 33.3% to 36.1% when comparing the ED between groups 1 and 2 and groups 3 and 4. CONCLUSIONS The 0.3- and 0.6-mm lead equivalent thickness protectors have a radiation attenuation effect of 78.1% to 78.5% and 90.4% to 90.8%, respectively. The 5-cm distance from the side of the table reduces radiation exposure by 33.3% to 36.1%.
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Affiliation(s)
- Cho Long Kim
- Department of Anesthesiology and Pain Medicine, Hanyang University Hospital, Seoul, Republic of Korea
- Department of Clinical Science, Konkuk University Graduate School of Medicine, Konkuk University School Seoul, Seoul, Republic of Korea
| | - Hae Chang Jeong
- Department of Anesthesiology and Pain Medicine, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Jae Hun Kim
- Department of Anesthesiology and Pain Medicine, Konkuk University School of Medicine, Seoul, Republic of Korea
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Tamaki Y, Yamashita K, Nakajima D, Omichi Y, Takahashi Y, Takai M, Tamaki S, Goto T, Hayashi H, Higashino K, Tsuruo Y, Sairyo K. Radiation exposure doses to the surgical team during hip surgery is significantly higher during lateral imaging than posteroanterior imaging: a cadaveric simulation study. J Occup Med Toxicol 2023; 18:27. [PMID: 38037166 PMCID: PMC10688452 DOI: 10.1186/s12995-023-00396-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 11/23/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND Fluoroscopy is indispensable when determining appropriate and effective interventions in orthopedic surgery. On the other hand, there is growing concern about the health hazards of occupational radiation exposure. The aim of this cadaveric simulation study was to measure radiation exposure doses to the surgical team during hip surgery. METHODS We reproduced the intraoperative setting of hip surgery using 7 fresh frozen cadavers (5 male, 2 female) to simulate patients and mannequins to simulate the surgeon, scrub nurse, and anesthesiologist. Six real-time dosimeters were mounted at sites corresponding to the optic lens, thyroid gland, chest, gonads, foot, and hand on each mannequin. The radiation exposure dose to each team member was measured during posteroanterior and lateral fluoroscopic imaging. RESULTS Radiation exposure doses to the surgeon were significantly higher during 3 min of lateral imaging than during 3 min of posteroanterior imaging at the optic lens (8.1 times higher), thyroid gland (10.3 times), chest (10.8 times), and hand (19.8 times) (p = 0.018, p = 0.018, p = 0.018, and p = 0.018, respectively). During lateral imaging, the radiation doses to the nurse were 0.16, 0.12, 0.09, 0.72, and 0.38 times those to the surgeon at the optic lens, thyroid, chest, gonads, and foot, respectively. The radiation dose to the anesthesiologist was zero at all anatomic sites during posteroanterior imaging and very small during lateral imaging. CONCLUSIONS Radiation exposure dose was significantly higher during lateral imaging up to 19.8 times comparing to the posteroanterior imaging. It is effective to reduce the lateral imaging time for reducing the intraoperative radiation exposure. In addition, appropriate distance from fluoroscopy resulted in very low exposure for nurses and anesthesiologists. Surgeon should pay attention that surgical staff do not get closer than necessary to the irradiation field.
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Affiliation(s)
- Yasuaki Tamaki
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15 Kuramoto, Tokushima, 770-8503, Japan
| | - Kazuta Yamashita
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15 Kuramoto, Tokushima, 770-8503, Japan.
| | - Daiki Nakajima
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15 Kuramoto, Tokushima, 770-8503, Japan
| | - Yasuyuki Omichi
- Department of Orthopedics, Tokushima Municipal Hospital, 2-34 Kitajosanjima, Tokushima, 770-0812, Japan
| | - Yoshinori Takahashi
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15 Kuramoto, Tokushima, 770-8503, Japan
| | - Michihiro Takai
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15 Kuramoto, Tokushima, 770-8503, Japan
| | - Shunsuke Tamaki
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15 Kuramoto, Tokushima, 770-8503, Japan
| | - Tomohiro Goto
- Department of Orthopedics, Tokushima Municipal Hospital, 2-34 Kitajosanjima, Tokushima, 770-0812, Japan
| | - Hiroaki Hayashi
- Department of Pharmaceutical and Health Sciences, Kanazawa University Graduate School, Kakuma-Machi, Kanazawa City, Ishikawa, 920-1192, Japan
| | - Kosaku Higashino
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15 Kuramoto, Tokushima, 770-8503, Japan
| | - Yoshihiro Tsuruo
- Department of Anatomy, Tokushima University Graduate School, 3-18-15 Kuramoto, Tokushima, 770-8503, Japan
| | - Koichi Sairyo
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15 Kuramoto, Tokushima, 770-8503, Japan
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Song C, Xia S, Zhang L, Wang K, Li H, Guo W, Zhu L, Lu Q. A novel endovascular robotic-assisted system for endovascular aortic repair: first-in-human evaluation of practicability and safety. Eur Radiol 2023; 33:7408-7418. [PMID: 37338556 PMCID: PMC10597873 DOI: 10.1007/s00330-023-09810-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 04/12/2023] [Accepted: 04/14/2023] [Indexed: 06/21/2023]
Abstract
OBJECTIVES To assess the practicability and safety of a novel endovascular robotic system for performing endovascular aortic repair in human. METHODS A prospective observational study was conducted in 2021 with 6 months post-operative follow-up. Patients with aortic aneurysms and clinical indications for elective endovascular aortic repair were enrolled in the study. The novel developed robotic system is applicable for the majority of commercial devices and various types of endovascular surgeries. The primary endpoint was technical success without in-hospital major adverse events. Technical success was defined as the ability of the robotic system to complete all procedural steps based on procedural segments. RESULTS The first-in-human evaluation of robot-assisted endovascular aortic repair was performed in five patients. The primary endpoint was achieved in all patients (100%). There were no device- or procedure-related complications or no in-hospital major adverse events. The operation time and total blood loss in these cases were equal to those in the manual procedures. The radiation exposure of the surgeon was 96.5% lower than that in the traditional position while the radiation exposure of the patients was not significantly increased. CONCLUSIONS Early clinical evaluation of the novel endovascular aortic repair in endovascular aortic repair demonstrated practicability, safety, and procedural effectiveness comparable to manual operation. In addition, the total radiation exposure of the operator was significantly lower than that of traditional procedures. CLINICAL RELEVANCE STATEMENT This study applies a novel approach to perform the endovascular aortic repair in a more accurate and minimal-invasive way and lays the foundation for the perspective automation of the endovascular robotic system, which reflects a new paradigm for endovascular surgery. KEY POINTS • This study is a first-in-human evaluation of a novel endovascular robotic system for endovascular aortic repair (EVAR). • Our system might reduce the occupational risks associated with manual EVAR and contribute to achieving a higher degree of precision and control. • Early evaluation of the endovascular robotic system demonstrated practicability, safety, and procedural effectiveness comparable to that of manual operation.
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Affiliation(s)
- Chao Song
- Department of Vascular Surgery, Shanghai Changhai Hospital, Naval Medical University, Shanghai, 200433, People's Republic of China
| | - Shibo Xia
- Department of Vascular Surgery, Shanghai Changhai Hospital, Naval Medical University, Shanghai, 200433, People's Republic of China
| | - Lei Zhang
- Department of Vascular Surgery, Shanghai Changhai Hospital, Naval Medical University, Shanghai, 200433, People's Republic of China
| | - Kundong Wang
- Department of Instrument Science and Engineering, Shanghai Jiao Tong University, Shanghai, 200240, People's Republic of China
| | - Haiyan Li
- Department of Vascular Surgery, Shanghai Changhai Hospital, Naval Medical University, Shanghai, 200433, People's Republic of China
| | - Wenying Guo
- Department of Vascular Surgery, Shanghai Changhai Hospital, Naval Medical University, Shanghai, 200433, People's Republic of China
| | - Longtu Zhu
- Department of Vascular Surgery, Shanghai Changhai Hospital, Naval Medical University, Shanghai, 200433, People's Republic of China
| | - Qingsheng Lu
- Department of Vascular Surgery, Shanghai Changhai Hospital, Naval Medical University, Shanghai, 200433, People's Republic of China.
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Sakafu L, Kiango V, Khasim Z, Shoo A, Ndossa M, Kagaruki G, Manyama D, Magandi J, Lee AY. Radiation safety in an era of diagnostic radiology growth in Africa: Lessons learned from Tanzania. Clin Imaging 2023; 102:65-70. [PMID: 37625349 DOI: 10.1016/j.clinimag.2023.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 08/07/2023] [Accepted: 08/16/2023] [Indexed: 08/27/2023]
Abstract
PURPOSE As radiology continues to grow in low- and middle-income countries (LMICs), radiation exposure and risk to patients and staff will concurrently increase. This study aims to assess the knowledge of radiation safety among medical staff in Tanzania. METHODS A survey was distributed to 350 staff members at a national referral hospital in Tanzania over a 7-month period (February-August 2021). This consisted of a structured questionnaire evaluating participants' knowledge and awareness ionizing radiation and radiation safety. Chi-square and Fisher's exact tests were used to determine the association between independent and dependent categorical variables. RESULTS A total of 300 surveys were completed (86% response rate). Mean age was 31 and 53% of participants were female. The majority (89%) were clinical staff employed in direct patient care. Most reported having heard of radiation protection (85%) but only 61% reported receiving training in radiation protection. Regarding radiation knowledge, 73% correctly answered how to protect oneself from radiation and 74% knew which medical staff were at greater risk of radiation exposure. However, only 32% correctly answered which imaging tests emit more radiation and only 53% correctly answered which age group was at greatest risk of radiation effects. Non-clinical staff had a significantly lower radiation awareness than clinical staff, with 69.7% reporting having heard about radiation protection, compared to 88.3% of clinical staff (p = 0.004). Female participants were more knowledgeable of radiation risks in pregnancy (p = 0.002). More early career staff reported receiving radiation protection training (64.5%) compared to those with >5 years work experience (53.9%), though this difference was not statistically significant (p = 0.09). When stratifying radiation knowledge by high (score of 80-100%), moderate (60-79.9%) and low (<60%), 20% of participants scored high, 47% moderate, and 33% low. CONCLUSION Most staff had low to moderate knowledge on radiation safety. Our findings highlight the importance of education on ionizing radiation as medical imaging continues to rise in Africa.
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Affiliation(s)
- Lulu Sakafu
- Department of Radiology, Muhimbili National Hospital-Mloganzila, Dar es Salaam, Tanzania.
| | - Violet Kiango
- Department of Radiology, Muhimbili National Hospital-Mloganzila, Dar es Salaam, Tanzania
| | - Zuwena Khasim
- Department of Radiology, Muhimbili National Hospital-Mloganzila, Dar es Salaam, Tanzania
| | - Aikankira Shoo
- Department of Radiology, Muhimbili National Hospital-Mloganzila, Dar es Salaam, Tanzania
| | - Mariam Ndossa
- Department of Radiology, Muhimbili National Hospital-Mloganzila, Dar es Salaam, Tanzania
| | - Gibson Kagaruki
- National Institute of Medical Research (NIMR), Mbeya, Tanzania
| | - Deogratius Manyama
- Department of Surgery, Muhimbili National Hospital-Mloganzila, Dar es Salaam, Tanzania
| | - Julieth Magandi
- Department of Surgery, Muhimbili National Hospital-Mloganzila, Dar es Salaam, Tanzania
| | - Amie Y Lee
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, United States of America
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Stine S, Joiner JD, Andersen D, Schweller E, Vaidya R. Transparency films: intraoperative templating to prevent limb deformity. OTA Int 2023; 6:e280. [PMID: 37601826 PMCID: PMC10438797 DOI: 10.1097/oi9.0000000000000280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 06/03/2023] [Indexed: 08/22/2023]
Abstract
Operative management of fractures and malunions can be challenging when restoring native anatomy is not straightforward. Comminuted fractures and managing deformity correction in the setting of osteolysis, callus, and even complete fracture healing must include careful planning. Preoperative planning has been popularized and taught as an integral part of a surgeon's skill set, with critical evaluation and assessment of the implemented plan being the final step in the process. We present a robust, reproducible, and cost-effective technique for intraoperative fracture fixation assessment with case examples, used routinely at our institution.
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Affiliation(s)
- Sasha Stine
- Wayne State University, Department of Orthopaedic Surgery, Detroit Medical Center, Detroit, MI
| | | | - Daniel Andersen
- Michigan State University College of Osteopathic Medicine, Lansing, MI
| | - Eric Schweller
- Michigan State University College of Osteopathic Medicine, Lansing, MI
| | - Rahul Vaidya
- Wayne State University, Department of Orthopaedic Surgery, Detroit Medical Center, Detroit, MI
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Zawadzki M, Pinkiewicz M, Pinkiewicz M, Walecki J, Walczak P, Gołubczyk D, Sady M, Gajewski Z. Real-Time MRI Monitoring of Liquid Embolic Agent (Onyx) Injection in a Swine Arteriovenous Malformation Model. Brain Sci 2023; 13:915. [PMID: 37371393 DOI: 10.3390/brainsci13060915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 05/30/2023] [Accepted: 06/03/2023] [Indexed: 06/29/2023] Open
Abstract
The paradigm is gradually shifting, with radiosurgery and endovascular embolization being increasingly chosen over surgical resection in the selected cases of brain arteriovenous malformations. Routinely used X-ray monitoring of liquid embolic infusion has very good spatial and temporal resolution but is not without significant drawbacks regarding poor visualization of the complex AVM angioarchitecture, especially after many embolizations in the past and therefore limiting the technical ability of the embocure-total occlusion of the feeding arteries, nidus, and draining veins. The purpose of this study was to evaluate the use of real-time MRI guidance in endovascular embolization with Onyx (instead of X-ray) in a single swine rete mirabile (RM) AVM model in order to provide the scaffolding for the real-time MRI guidance method. Onyx propagation was observed in real-time dynamic GE-EPI scan with initial ipsilateral RM filling followed by main cerebral arterial branch distribution. The relatively bright signal within RM and the brain prior to Onyx injection provided a good background for the dark, low signal of the embolic agent spreading in rete mirabile and brain arteries. X-ray picture confirmed Onyx cast distribution at the end of the procedure. In this initial experience, real-time MRI seems to be a promising method that may significantly improve liquid embolic agent infusion monitoring in the future, although requiring further development before clinical use.
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Affiliation(s)
- Michał Zawadzki
- Department of Radiology, Centre of Postgraduate Medical Education, 01-813 Warsaw, Poland
- Division of Interventional Neuroradiology, Department of Radiology, The National Institute of Medicine of the Ministry of Interior and Administration, 02-507 Warsaw, Poland
| | - Miłosz Pinkiewicz
- Faculty of Medicine, Wroclaw Medical University, 50-368 Wrocław, Poland
| | - Mateusz Pinkiewicz
- Department of Diagnostic Imaging, Mazowiecki Regional Hospital in Siedlce, 08-110 Siedlce, Poland
| | - Jerzy Walecki
- Department of Radiology, Centre of Postgraduate Medical Education, 01-813 Warsaw, Poland
- Division of Interventional Neuroradiology, Department of Radiology, The National Institute of Medicine of the Ministry of Interior and Administration, 02-507 Warsaw, Poland
| | - Piotr Walczak
- Program in Image Guided Neurointerventions, Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland, Baltimore, MD 21201, USA
| | - Dominika Gołubczyk
- Center for Translational Medicine, Warsaw University of Life Sciences, 02-787 Warsaw, Poland
| | - Maria Sady
- Center for Translational Medicine, Warsaw University of Life Sciences, 02-787 Warsaw, Poland
| | - Zdzisław Gajewski
- Center for Translational Medicine, Warsaw University of Life Sciences, 02-787 Warsaw, Poland
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Ikezawa K, Hayashi S, Takenaka M, Yakushijin T, Nagaike K, Takada R, Yamai T, Matsumoto K, Yamamoto M, Omoto S, Minaga K, Ishii S, Shimizu T, Nagai K, Hosono M, Nishida T. Occupational radiation exposure to the lens of the eyes and its protection during endoscopic retrograde cholangiopancreatography. Sci Rep 2023; 13:7824. [PMID: 37188704 DOI: 10.1038/s41598-023-34740-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Accepted: 05/06/2023] [Indexed: 05/17/2023] Open
Abstract
This study aimed to examine occupational radiation exposure to the lens of the eyes during endoscopic retrograde cholangiopancreatography (ERCP). In this multicenter, prospective, observational cohort study, we collected data regarding occupational radiation exposure to the lens of the eyes during ERCP. We measured radiation exposure of patients and examined its correlation with occupational exposure. In dosimetrically-measured ERCPs (n = 631), the median air kerma at the patient entrance reference point, air kerma-area product, and fluoroscopy time were 49.6 mGy, 13.5 Gycm2, and 10.9 min, respectively. The median estimated annual radiation dose to the lens of the eyes was 3.7, 2.2, and 2.4 mSv for operators, assistants, and nurses, respectively. Glass badge over lead aprons and eye dosimeter results were similar in operators but differed in assistants and nurses. A strong correlation was shown between eye dosimeter measurements and patients' radiation exposure. The shielding rates of the lead glasses were 44.6%, 66.3%, and 51.7% for operators, assistants, and nurses, respectively. This study revealed the actual occupational exposure dose for the lens of the eyes during ERCP and the efficacy of lead glass. Values of radiation exposure to patients can help estimate exposure to the lens of the eyes of medical staff.
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Affiliation(s)
- Kenji Ikezawa
- Department of Hepatobiliary and Pancreatic Oncology, Osaka International Cancer Institute, Osaka, Osaka, Japan.
| | - Shiro Hayashi
- Department of Gastroenterology, Toyonaka Municipal Hospital, Toyonaka, Osaka, Japan
- Department of Gastroenterology and Internal Medicine, Hayashi Clinic, Suita, Osaka, Japan
| | - Mamoru Takenaka
- Department of Gastroenterology and Hepatology, Faculty of Medicine, Kindai University, Osaka-Sayama, Osaka, Japan
| | - Takayuki Yakushijin
- Department of Gastroenterology and Hepatology, Osaka General Medical Center, Osaka, Osaka, Japan
| | - Koji Nagaike
- Department of Gastroenterology and Hepatology, Suita Municipal Hospital, Suita, Osaka, Japan
| | - Ryoji Takada
- Department of Hepatobiliary and Pancreatic Oncology, Osaka International Cancer Institute, Osaka, Osaka, Japan
| | - Takuo Yamai
- Department of Hepatobiliary and Pancreatic Oncology, Osaka International Cancer Institute, Osaka, Osaka, Japan
| | - Kengo Matsumoto
- Department of Gastroenterology, Toyonaka Municipal Hospital, Toyonaka, Osaka, Japan
| | - Masashi Yamamoto
- Department of Gastroenterology, Toyonaka Municipal Hospital, Toyonaka, Osaka, Japan
| | - Shunsuke Omoto
- Department of Gastroenterology and Hepatology, Faculty of Medicine, Kindai University, Osaka-Sayama, Osaka, Japan
| | - Kosuke Minaga
- Department of Gastroenterology and Hepatology, Faculty of Medicine, Kindai University, Osaka-Sayama, Osaka, Japan
| | - Shuji Ishii
- Department of Gastroenterology and Hepatology, Osaka General Medical Center, Osaka, Osaka, Japan
| | - Takeshi Shimizu
- Department of Gastroenterology and Hepatology, Osaka General Medical Center, Osaka, Osaka, Japan
| | - Kengo Nagai
- Department of Gastroenterology and Hepatology, Suita Municipal Hospital, Suita, Osaka, Japan
| | - Makoto Hosono
- Department of Radiology, Kindai University Faculty of Medicine, Osaka-Sayama, Osaka, Japan
| | - Tsutomu Nishida
- Department of Gastroenterology, Toyonaka Municipal Hospital, Toyonaka, Osaka, Japan
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Plimon M, Falkensammer J, Taher F, Hofmann A, Assadian A. Remote training and evaluation of a simulator-based training course for complex endovascular procedures. Eur Surg 2023; 55:84-88. [PMID: 37206193 PMCID: PMC10153769 DOI: 10.1007/s10353-023-00799-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 03/15/2023] [Indexed: 05/21/2023]
Abstract
Background Intimate knowledge of the materials used in endovascular aortic interventions is essential for trainees and supporting staff taking part in an endovascular intervention. Training courses can help to familiarize trainees with the equipment. However, the pandemic has changed the landscape of hands-on training courses significantly. Therefore, we developed a training course including an educational recording of the procedure to transfer knowledge about the materials used during endovascular interventions and radiation exposure reduction. Methods We produced a video depicting cannulation of the left renal artery in a silicon cast of an aorta and its major side branches under C‑arm fluoroscopy. A presentation using the video was given to the trainees. The trainees were randomized into a control and an intervention group. Their performance was filmed and rated on a standardized five-point scale in the style of the OSATS global rating scale. The intervention group was remeasured after additional training time. Results In total, 23 trainees participated in the training and agreed to have their performance recorded. The control and intervention groups showed no difference in the assessed performance metrics during their initial attempt. However, after receiving additional training, the intervention group significantly improved in all evaluated metrics. Conclusion Our data add to the growing evidence that simulator-based training can help to increase trainees' understanding and performance of relevant skills. A standardized and evidence-based validation process for simulators could improve their acceptance in the medical field.
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Affiliation(s)
- Markus Plimon
- Department of Vascular and Endovascular Surgery, Klinik Ottakring, Montleartstraße 37, Pavillon 30B, 1160 Vienna, Austria
| | - Jürgen Falkensammer
- Department of Vascular Surgery, Krankenhaus Barmherzige Brüder, Linz, Austria
| | - Fadi Taher
- Department of Vascular and Endovascular Surgery, Klinik Ottakring, Montleartstraße 37, Pavillon 30B, 1160 Vienna, Austria
| | - Amun Hofmann
- Department of Vascular and Endovascular Surgery, Klinik Ottakring, Montleartstraße 37, Pavillon 30B, 1160 Vienna, Austria
| | - Afshin Assadian
- Department of Vascular and Endovascular Surgery, Klinik Ottakring, Montleartstraße 37, Pavillon 30B, 1160 Vienna, Austria
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Potočnik J, Foley S, Thomas E. Current and potential applications of artificial intelligence in medical imaging practice: A narrative review. J Med Imaging Radiat Sci 2023; 54:376-385. [PMID: 37062603 DOI: 10.1016/j.jmir.2023.03.033] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 03/25/2023] [Accepted: 03/28/2023] [Indexed: 04/18/2023]
Abstract
BACKGROUND AND PURPOSE Artificial intelligence (AI) is present in many areas of our lives. Much of the digital data generated in health care can be used for building automated systems to bring improvements to existing workflows and create a more personalised healthcare experience for patients. This review outlines select current and potential AI applications in medical imaging practice and provides a view of how diagnostic imaging suites will operate in the future. Challenges associated with potential applications will be discussed and healthcare staff considerations necessary to benefit from AI-enabled solutions will be outlined. METHODS Several electronic databases, including PubMed, ScienceDirect, Google Scholar, and University College Dublin Library Database, were used to identify relevant articles with a Boolean search strategy. Textbooks, government sources and vendor websites were also considered. RESULTS/DISCUSSION Many AI-enabled solutions in radiographic practice are available with more automation on the horizon. Traditional workflow will become faster, more effective, and more user friendly. AI can handle administrative or technical types of work, meaning it is applicable across all aspects of medical imaging practice. CONCLUSION AI offers significant potential to automate most of the manual tasks, ensure service consistency, and improve patient care. Radiographers, radiation therapists, and clinicians should ensure they have adequate understanding of the technology to enable ethical oversight of its implementation.
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Affiliation(s)
- Jaka Potočnik
- University College Dublin School of Medicine, Radiography & Diagnostic Imaging, Room A223, Belfield, Dublin 4, Ireland.
| | - Shane Foley
- University College Dublin School of Medicine, Radiography & Diagnostic Imaging, Room A223, Belfield, Dublin 4, Ireland
| | - Edel Thomas
- University College Dublin School of Medicine, Radiography & Diagnostic Imaging, Room A223, Belfield, Dublin 4, Ireland
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Choi TW, Chung JW, Kwon Y. Modified design of x-ray protective clothing to enhance radiation protection for interventional radiologists. Med Phys 2023. [PMID: 36794321 DOI: 10.1002/mp.16309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 02/01/2023] [Accepted: 02/01/2023] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND In interventional radiology procedures, the operator typically stands on the right side of the patient's right thigh to manipulate devices through the femoral sheath. Because the standard x-ray protective clothing is designed as sleeveless and scatter radiations from the patient are mainly incident from the left-anterior direction to the operator, the arm hole of the clothing may be a significant unprotected area, contributing to an increase in the operator's organ doses and effective dose. PURPOSE This study aimed to compare the organ doses and effective dose received by the interventional radiologist when wearing the standard x-ray protective clothing and when wearing the modified clothing with an additional shoulder guard. METHODS The experimental setup aimed to simulate actual clinical practice in interventional radiology. The patient phantom was located at the beam center to generate scatter radiation. An adult female anthropomorphic phantom loaded with 126 nanoDots (Landauer Inc., Glenwood, IL) was used to measure organ and effective doses to the operator. The standard wrap-around type x-ray protective clothing offered 0.25-mm lead-equivalent protection, and the frontal overlap area offered 0.50-mm lead-equivalent protection. The shoulder guard was custom-made with a material providing x-ray protection equivalent to lead of 0.50 mm thickness. The organ and effective doses were compared between the operator wearing the standard protective clothing and the one wearing the modified clothing with a shoulder guard. RESULTS After adding the shoulder guard, doses to the lungs, bone marrow, and esophagus decreased by 81.9%, 58.6%, and 58.7%, respectively, and the effective dose to the operator decreased by 47.7%. CONCLUSIONS Widespread use of modified x-ray protective clothing with shoulder guards can significantly decrease the overall occupational radiation risk in interventional radiology.
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Affiliation(s)
- Tae Won Choi
- Department of Radiology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Jin Wook Chung
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea.,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea
| | - Yohan Kwon
- Department of Radiology, Ajou University School of Medicine, Suwon, Republic of Korea
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Modarai B, Haulon S, Ainsbury E, Böckler D, Vano-Carruana E, Dawson J, Farber M, Van Herzeele I, Hertault A, van Herwaarden J, Patel A, Wanhainen A, Weiss S, Esvs Guidelines Committee, Bastos Gonçalves F, Björck M, Chakfé N, de Borst GJ, Coscas R, Dias NV, Dick F, Hinchliffe RJ, Kakkos SK, Koncar IB, Kolh P, Lindholt JS, Trimarchi S, Tulamo R, Twine CP, Vermassen F, Document Reviewers, Bacher K, Brountzos E, Fanelli F, Fidalgo Domingos LA, Gargiulo M, Mani K, Mastracci TM, Maurel B, Morgan RA, Schneider P. Editor's Choice - European Society for Vascular Surgery (ESVS) 2023 Clinical Practice Guidelines on Radiation Safety. Eur J Vasc Endovasc Surg 2023; 65:171-222. [PMID: 36130680 DOI: 10.1016/j.ejvs.2022.09.005] [Citation(s) in RCA: 36] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 09/15/2022] [Indexed: 01/24/2023]
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15
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Rabah M, Allen S, Abbas AE, Dixon S. A novel comprehensive radiation shielding system eliminates need for personal lead aprons in the catheterization laboratory. Catheter Cardiovasc Interv 2023; 101:79-86. [PMID: 36453459 DOI: 10.1002/ccd.30490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 10/27/2022] [Accepted: 11/02/2022] [Indexed: 12/04/2022]
Abstract
OBJECTIVES This clinical study evaluated the efficacy of a novel radiation shielding system for the cardiac catheterization laboratory designed to provide comprehensive protection that obviates the need for personal lead aprons. BACKGROUND Invasive Cardiologists are exposed to occupational health hazards related directly to radiation exposure (RE) and indirectly to the orthopedic burden of wearing only partially protective lead aprons. Innovations to reduce these risks are warranted. A novel comprehensive shielding system (ProtegoTM , Image Diagnostics Inc, Fitchburg, Ma) has been validated in pre-clinical studies to provide excellent radiation protection, sufficient for the State of Michigan to certify it for use without need for personal lead aprons. METHODS This clinical analysis measured RE to a single Physician operator utilizing the ProtegoTM shield (and not wearing personal lead apron) during routine cardiac catheterization procedures (diagnostic and interventional). RE was measured at both thyroid and waist level with a real-time dosimetry system (RaysafeTM , Billdal, Sweden), calculated on a median per case basis (mrems). Additional parameters collected included procedure type, access site, per case fluoroscopy time, and patient factors including body mass index. RESULTS In n=98 cases (25% diagnostic, 75% interventional including 22% chronic total occlusions), median/case RE was 0.4 mrems (thyroid) and 0.2 mrems (waist). RE=0 in 12 cases. In no case did radiation exposure exceed 3.2 mrems. CONCLUSION The ProtegoTM shield system provides excellent RE protection to the Physician operator, without the need for personal lead aprons and has the potential to reduce catheterization laboratory occupational health hazards.
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Affiliation(s)
- Maher Rabah
- Department of Cardiovascular Medicine, Beaumont Hospitals, Royal Oak, Michigan, USA
| | - Sorcha Allen
- Department of Cardiovascular Medicine, Beaumont Hospitals, Royal Oak, Michigan, USA
| | - Amr E Abbas
- Department of Cardiovascular Medicine, Beaumont Hospitals, Royal Oak, Michigan, USA
| | - Simon Dixon
- Department of Cardiovascular Medicine, Beaumont Hospitals, Royal Oak, Michigan, USA
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Wang P, Zhang J, Chen Y, He Y, Shen L, Jiang M, Yang Z, Zheng J, Wang Z, Zhu J. The satisfaction with radiology residency training in China: results of a nationwide survey. Insights Imaging 2022; 13:196. [PMID: 36520298 PMCID: PMC9753880 DOI: 10.1186/s13244-022-01329-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 11/09/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND National data on the satisfaction of radiology residents enrolled in standardized residency training (SRT) are rather scarce in China. This study identified a set of potential factors concerning SRT satisfaction among radiology residents as well as the association between SRT satisfaction and post-competency and well-being. METHODS A total of 3666 radiology residents who were receiving SRT during 2020 in China were recruited across all 31 provinces. The cumulative odds logistic regression was used to examine the potential factors associated with SRT satisfaction as well as associations between satisfaction and well-being, burnout, professional identity and competency. RESULTS The prevalence of satisfaction with SRT was 68.6%. Participants who were male, worked in central China, aged more than 28 years old, had long working hours and claimed increased workload during the COVID-19 pandemic were more likely to be unsatisfied with the SRT program. Participants who were more satisfied with the radiation protection were more likely to report higher degree of SRT satisfaction (OR = 3.00, 95% CI 2.58-3.50). In addition, SRT satisfaction was positively associated with well-being, professional identity, competency and lower burnout. CONCLUSIONS Perceived satisfaction can be introduced into hospital management, as it may reflect the overall situation of the residents during residency training and influence radiologists' well-being, professional identification and competency. Appropriate measures should be taken to reduce the risk of radiation exposure, ensure employee safety (such as risk assessment system and paid time off), provide radiology residents with fair treatment and guarantee the time out of working for optimizing their professional ability.
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Affiliation(s)
- Peicheng Wang
- grid.12527.330000 0001 0662 3178Vanke School of Public Health, Tsinghua University, Haidian District, Beijing, 100084 China ,grid.12527.330000 0001 0662 3178School of Medicine, Tsinghua University, Beijing, China
| | - Jingfeng Zhang
- grid.9227.e0000000119573309Department of Radiology, Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo, China
| | - Yanhua Chen
- grid.12527.330000 0001 0662 3178Vanke School of Public Health, Tsinghua University, Haidian District, Beijing, 100084 China ,grid.12527.330000 0001 0662 3178School of Medicine, Tsinghua University, Beijing, China
| | - Yanrong He
- grid.12527.330000 0001 0662 3178Vanke School of Public Health, Tsinghua University, Haidian District, Beijing, 100084 China
| | - Lijun Shen
- grid.12527.330000 0001 0662 3178Vanke School of Public Health, Tsinghua University, Haidian District, Beijing, 100084 China ,grid.12527.330000 0001 0662 3178School of Medicine, Tsinghua University, Beijing, China
| | - Maoqing Jiang
- grid.9227.e0000000119573309Department of Radiology, Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo, China
| | - Zhenghan Yang
- grid.24696.3f0000 0004 0369 153XDepartment of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Jianjun Zheng
- grid.9227.e0000000119573309Department of Radiology, Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo, China
| | - Zhenchang Wang
- grid.24696.3f0000 0004 0369 153XDepartment of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Jiming Zhu
- grid.12527.330000 0001 0662 3178Vanke School of Public Health, Tsinghua University, Haidian District, Beijing, 100084 China ,grid.12527.330000 0001 0662 3178School of Medicine, Tsinghua University, Beijing, China ,grid.12527.330000 0001 0662 3178Institute for Healthy China, Tsinghua University, Beijing, China
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Baker A, Narayanan S, Tsai JP, Tjoumakaris SI, Haranhalli N, Fraser JF, Hetts SW. Society of NeuroInterventional Surgery: position statement on pregnancy and parental leave for physicians practicing neurointerventional surgery. J Neurointerv Surg 2022; 15:5-7. [DOI: 10.1136/jnis-2022-019613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 10/25/2022] [Indexed: 11/18/2022]
Abstract
BackgroundThe aim of this article is to outline a position statement on pregnancy and parental leave for physicians practicing neurointerventional surgery.MethodsWe performed a structured literature review regarding parental leave policies in neurointerventional surgery and related fields. The recommendations resulted from discussion among the authors, and additional input from the Women in NeuroIntervention Committee, the full Society of NeuroInterventional Surgery (SNIS) Standards and Guidelines Committee, and the SNIS Board of Directors.ResultsSome aspects of workplace safety during pregnancy are regulated by the US Nuclear Regulatory Commission. Other aspects of the workplace and reasonable job accommodations are legally governed by the Family and Medical Leave Act of 1993, the Affordable Care Act of 2010 and the Fair Labor Standards Act of 1938, Americans with Disabilities Act of 1990, Title IX of the Education Amendments of 1972, Title VII of the Civil Rights Act of 1964 as well as rights and protections put forth by the Occupational Safety and Health Administration as part of the United States Department of Labor. Family friendly policies have been associated not only with improved job satisfaction but also with improved parental and infant outcomes. Secondary effects of such accommodations are to increase the number of women within the specialty.ConclusionsSNIS supports a physician’s ambition to have a family as well as start, develop, and maintain a career in neurointerventional surgery. Legal and regulatory mandates and family friendly workplace policies should be considered when institutions and individual practitioners approach the issue of childbearing in the context of a career in neurointerventional surgery.
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Rose A, Rae WI, Sweetlove MA, Ngetu L, Benadjaoud MA, Marais W. Radiation induced cataracts in interventionalists occupationally exposed to ionising radiation. SA J Radiol 2022; 26:2495. [PMID: 36262829 PMCID: PMC9575381 DOI: 10.4102/sajr.v26i1.2495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 07/06/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Occupational exposure to ionising radiation may have detrimental health effects. Longer and more complex fluoroscopic procedures have placed interventionalists at increased occupational health risks especially for developing cataracts in the radiosensitive lenses of the eyes. OBJECTIVES This study aimed to determine the prevalence of occupational related cataracts and describe the risk factors for cataracts in occupationally exposed interventionalists compared with unexposed doctors. METHOD A cross-sectional study using multiple methods. A survey was conducted. The radiation workload was determined based on a self-administered questionnaire and dose area product values determined in previous studies. Both groups had slit lamp examinations. The data were analysed analytically using R software version 9.3. RESULTS The study included 98 interventionalists. The combined prevalence of posterior sub-capsular (PSC) and cortical cataracts was 18.8% in the exposed and 13.9% in the unexposed group. The prevalence of PSC cataracts in the exposed group was 5.9% and 2.8% in the unexposed group, with an odds ratio (OR) of 2.2 (95% confidence interval [CI]: 0.58; 8.61). Posterior sub-capsular cataracts were more common in the left eye. The increase in cataracts was not statistically significant in the exposed group but is of clinical significance. CONCLUSION The findings are important as they highlight the need for greater vigilance for protecting the radiation healthcare workforce in a developing country setting. CONTRIBUTION The research is the first of its kind in South Africa and Africa and contributes to determining the prevalence in this highly skilled and occupationally vulnerable group.
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Affiliation(s)
- André Rose
- Center for Health Systems Research and Development, Faculty of Humanities, University of the Free State, Bloemfontein, South Africa
| | - William I.D. Rae
- Prince of Wales Hospital, Faculty of Medical Imaging, University of Sydney, Sydney, Australia
| | - Margaret A. Sweetlove
- Department of Medical Physics, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
| | - Lumko Ngetu
- Department of Ophthalmology, Faculty of Health, University of the Free State, Bloemfontein, South Africa
| | - Mohamed A. Benadjaoud
- Institute for Radiological Protection and Nuclear Safety (IRSN), Fontenay-aux-Roses, France,Department of Radiobiology and Regenerative Medicine (SERAMED), Fontenay-aux-Roses, France
| | - Wayne Marais
- Department of Ophthalmology, Faculty of Health, University of the Free State, Bloemfontein, South Africa
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Hattori S, Monzen H, Tamura M, Kosaka H, Nakamura Y, Nishimura Y. Estimating radiation exposure of the brain of a physician with a protective flap in interventional radiology: A phantom study. J Appl Clin Med Phys 2022; 23:e13532. [PMID: 35045212 PMCID: PMC8906205 DOI: 10.1002/acm2.13532] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 08/30/2021] [Accepted: 12/18/2021] [Indexed: 11/09/2022] Open
Abstract
PURPOSE The efficiency of protective equipment for the brain has not been verified at the left anterior oblique (LAO) position, which is commonly used in clinical procedures. The purpose of this study was to investigate radiation exposure of the brain in interventional radiology (IR) and the shielding ability of a new protective flap. METHODS We made a flap that combined a protective cap with a left lateral face shield. The flap was made of tungsten-containing rubber (TCR). An anthropomorphic head phantom was placed at the physician's position, and air kerma rates (μGy/min and μGy/15s) were measured by electronic dosimeter at three locations: the surface of the left side of the head, and the left and right temporal lobes with the protective cap and the flap in fluoroscopy and cine modes. The X-ray tube was at the lower left side of the physician, and its angles were LAO60 and LAO60CAU40. The tube voltage (95-125 kV), tube current (4.7-732 mA), and air kerma rate (27.8-1078 mGy/min) were automatically adjusted by the X-ray system. We obtained the cap and the flap shielding efficiencies. RESULTS In cine mode at LAO60CAU40, the shielding efficiencies on the surface of the left side of the head and left temporal lobe with the cap were 92.6% and 5.1%, respectively, and the corresponding shielding efficiencies with the flap were 92.5% and 86.1%, respectively. The flap can reduce radiation exposure of the brain more than the cap alone. CONCLUSIONS At the left anterior oblique in interventional radiology, the flap can reduce exposure to the brain.
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Affiliation(s)
- Shota Hattori
- Department of Medical Physics, Graduate School of Medical Sciences, Kindai University, Osakasayama, Osaka, Japan.,Department of Radiological Center, Kindai University Hospital, Osakasayama, Osaka, Japan
| | - Hajime Monzen
- Department of Medical Physics, Graduate School of Medical Sciences, Kindai University, Osakasayama, Osaka, Japan
| | - Mikoto Tamura
- Department of Medical Physics, Graduate School of Medical Sciences, Kindai University, Osakasayama, Osaka, Japan
| | - Hiroyuki Kosaka
- Department of Medical Physics, Graduate School of Medical Sciences, Kindai University, Osakasayama, Osaka, Japan.,Department of Radiological Center, Kindai University Hospital, Osakasayama, Osaka, Japan
| | - Yasunori Nakamura
- Department of Medical Physics, Graduate School of Medical Sciences, Kindai University, Osakasayama, Osaka, Japan
| | - Yasumasa Nishimura
- Department of Radiation Oncology, Faculty of Medicine, Kindai University, Osakasayama, Osaka, Japan
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Branach C, Tharp K, Duszak R. Distribution and Characteristics of Malpractice and Nonmalpractice Litigation Involving Interventional Radiologists in the United States from 1983-2018. Curr Probl Diagn Radiol 2021; 50:803-806. [DOI: 10.1067/j.cpradiol.2020.11.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 10/23/2020] [Accepted: 11/09/2020] [Indexed: 12/29/2022]
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Association of occupational direct radiation exposure to the hands with longitudinal melanonychia and hand eczema in spine surgeons: a survey by the society for minimally invasive spinal treatment (MIST). EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2021; 30:3702-3708. [PMID: 34427761 DOI: 10.1007/s00586-021-06973-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 05/19/2021] [Accepted: 08/18/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To investigate the association between occupational direct radiation exposure to the hands and longitudinal melanonychia (LM) and hand eczema in spine surgeons. METHODS A web-based questionnaire survey of the Society for Minimally Invasive Spinal Treatment (MIST) in Japan was conducted. The proportion of LM and hand eczema in hands with high and low-radiation exposure was compared using Fisher's exact test. The odds ratios (ORs) and their 95% confidence intervals (CIs) for the prevalence of LM and hand eczema in the high-radiation exposure hands were calculated using generalized estimating equations for logistic regression as control for the correlation of observations among the same individuals and possible confounders. RESULTS Among 324 members of the society, responses were received from 229 members (70.7%). A total of 454 hands from 227 participants were analysed. The prevalence of LM and hand eczema was 43% and 29%, respectively. In a hand-by-hand comparison, more hands had LM in the high-radiation exposure group than the low-radiation exposure group (90 [40%] vs. 39 [17%], respectively, p < 0.001). A similar trend was observed for hand eczema (63 [28%] vs. 33 [15%], respectively, p = 0.001). The adjusted OR for high-radiation exposure hands was 3.18 (95% CI: 2.24-4.52). Consistent results were obtained for hand eczema, with an adjusted OR of 2.26 (95% CI: 1.67-3.06). CONCLUSION The present study suggests that direct radiation exposure to physician's hands is associated with LM and hand eczema. Those with LM and radially biased hand eczema may have had high direct radiation exposure.
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Sogade OO, Aben RN, Eyituoyo H, Arinze NC, Sogade FO. Feasibility study for echocardiography-guided lead insertion for permanent cardiac implantable electronic devices. Pacing Clin Electrophysiol 2021; 44:1365-1370. [PMID: 34121208 PMCID: PMC8457189 DOI: 10.1111/pace.14296] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 04/26/2021] [Accepted: 06/02/2021] [Indexed: 11/29/2022]
Abstract
Background Permanent cardiac implantable electronic devices (CIEDs) are traditionally implanted with the assistance of fluoroscopy. While clinically effective, this technique exposes both patients and providers to radiation which is associated with adverse health effects and represents an occupational hazard. In this study, we investigate the safety and feasibility of permanent CIED placement under the guidance of transthoracic echocardiography (TTE). There is also increasing interest in use of non‐fluoroscopic options for noninvasive cardiac electrophysiologic procedures. Methods Fifteen patients consecutively consented for initial implant of CIEDs, specifically dual chamber pacemakers (DCPM) and dual chamber implantable cardioverter defibrillators (DCICDs). Patients were excluded if they had previous implants, abandoned leads, or anatomic anomalies including congenital and known persistent left superior vena cava (PLSVC). We used TTE to guide and implant atrial and ventricular leads. Results Eleven patients received DCPMs and four patients received DCICDs. The procedure duration was 49.3 min for DCICD and 52.3 min for DCPM, p = .807. The average number of right atrial lead attempts was 1.6 for DCPMs and 1.8 for DCICD, p = .860. The average number of right ventricular lead attempts for DCPMs was 2.2 and 1.0 attempt for DCICDs, p = .044. There were no complications at 90‐day follow‐up. Conclusion We demonstrate the feasibility of TTE‐guided DCPM/DCICD implantation without use of fluoroscopy. We present this method as a safe alternative for permanent CIED placement that may reduce risk of radiation exposure and cost while maintaining safety and efficacy. No operators wore lead aprons during the procedure.
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Affiliation(s)
- Omolade O Sogade
- Washington University School of Medicine, St. Louis, Missouri, USA
| | - Rieta N Aben
- Georgia Arrhythmia Consultants, Macon, Georgia, USA.,Department of Medicine, Mercer University School of Medicine, Macon, Georgia, USA
| | - Harry Eyituoyo
- Georgia Arrhythmia Consultants, Macon, Georgia, USA.,Department of Medicine, Mercer University School of Medicine, Macon, Georgia, USA
| | - Nkechi C Arinze
- Georgia Arrhythmia Consultants, Macon, Georgia, USA.,Department of Medicine, Mercer University School of Medicine, Macon, Georgia, USA
| | - Felix O Sogade
- Georgia Arrhythmia Consultants, Macon, Georgia, USA.,Department of Medicine, Mercer University School of Medicine, Macon, Georgia, USA
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Rose A, Uebel K, Rae WID. Personal dosimeter utilisation among South African interventionalists. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2021; 41:326-336. [PMID: 33873176 DOI: 10.1088/1361-6498/abf950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 04/19/2021] [Indexed: 06/12/2023]
Abstract
Ionising radiation (IR) is increasingly being used in diagnostic and therapeutic procedures and offers increased benefits to patients but poses an increased occupational health risk to operators. The consistent use and monitoring of radiation health care workers' dosimeters is an important part of the process for ensuring adequate monitoring and control of IR in the workplace. There is however often inconsistent dosimeter utilisation among these workers. The aim of this study was to report on the dosimeter utilisation and dosimetry practices in South African interventionalists. We conducted a survey and did in-depth and group interviews to evaluate dosimetry practices and the factors influencing these practices. We used STATA 15 to do a descriptive analysis of the quantitative data. A thematic analysis of the qualitative data was done using a deductive and inductive approach. There were 108 respondents (35 radiologists, 41 adult cardiologists, 32 paediatric cardiologists). The majority overall (65.8%), and in each category were males. The median age was 44 (interquartile range (IQR) 31-66)) and the median years worked with fluoroscopy was 10 years (IQR 1-32). Overall interventionalists (55%) ranked their perceived occupation risk as 2/10. Thirteen per cent of all interventionalists reported never using a personal dosimeter (PD), 58% reported wearing it >70% of the time. Inconsistent and inappropriate use of PDs emerged strongly from the qualitative data. There was poor dosimeter utilisation in this study. Participants were not aware of the role of medical physics departments. Evaluation of dosimetry practices as a means of monitoring and improving radiation safety in the catheterisation laboratory must be improved to create an improved culture of radiation safety and protection.
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Affiliation(s)
- André Rose
- Centre for Health Systems Research and Development, University of the Free State, South Africa
| | - Kerry Uebel
- School of Public Health and Community Medicine, University of New South Wales, Australia
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24
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Supawat B, Wattanapongpitak S, Tima S, Kothan S, Tungjai M. Effect of fluoroscopic X-rays combined with iodinated radiographic contrast media on human hematological parameters. TOXICOLOGY AND ENVIRONMENTAL HEALTH SCIENCES 2021. [DOI: 10.1007/s13530-021-00093-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Bawazeer O. Quality Assurance of Personal Radiation Shield for Kilovoltage Photon: A Multicentre Experience. Risk Manag Healthc Policy 2021; 14:1263-1270. [PMID: 33790671 PMCID: PMC8005366 DOI: 10.2147/rmhp.s298783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 03/11/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To optimize the maintenance of radiation shields, this study aims to analyze annual inspection files to assess the integrity of radiation shields and their associated factors with regard to defects in radiation shields in clinical settings. Methods A multicenter cross-sectional study was conducted at hospitals in Saudi Arabia. The data from annual inspection files of 1019 clinical lead radiation shields were analyzed. The factors of shield shape, unit where a shield is used, shield thickness, short-term use and number of users were examined. In addition to the inspection file analysis, radiation attenuation measurements were obtained for a subset of shields to compare newly purchased shields with older shields. Statistical analyses were performed using Fisher's exact test and a t-test. Results The results show that the highest percentage of failing shields were found in the emergency unit, fluoroscopy unit and operation room with a failure of approximately 7.14%, 5.61%, and 3.98%, respectively, of these shields. Fluoroscopy and operation room units were statistically significantly associated with shield defects. There was no association between shield damage and shape of shield, shield thickness, short-term use or number of users. Radiation attenuation measurements were similar for new and older shields. Conclusion As fluoroscopy units and operating rooms have a higher percentage of damaged shields, it is recommended that the shields employed in these units should be regularly inspected more frequently than once a year. The study highlights that the shields' age, transmission measurements that confirm that the correct shields are purchased according to the required kVp, physical appearance, and cleanliness should be recorded in annual inspection files. This study highlights the need for uniform inspection files of radiation shields across hospitals. National and international organizations may apply these findings to develop appropriate recommendations.
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Affiliation(s)
- Omemh Bawazeer
- Medical Physics Department, Umm Al-Qura University, Mecca, Saudi Arabia
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26
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Chauhan V, Villeneuve D, Cool D. Collaborative efforts are needed among the scientific community to advance the adverse outcome pathway concept in areas of radiation risk assessment. Int J Radiat Biol 2021; 97:815-823. [PMID: 33253609 PMCID: PMC8312481 DOI: 10.1080/09553002.2020.1857456] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 11/05/2020] [Accepted: 11/23/2020] [Indexed: 12/21/2022]
Abstract
Disease prevention and prediction have led to the generation of phenotypically based methods for deriving the limits of safety across toxicological disciplines. In the ionizing radiation field, human data has formed the basis of the linear-no-threshold (LNT) model for risk estimates. However, uncertainties around its accuracy at low doses and low dose-rates have led to passionate debates on its effectiveness to derive radiation risk estimates under these conditions. Concerns arise from the linear extrapolation of data from high doses to low doses, below 0.1 Gy where there is considerable variability in the scientific literature. Efforts to address these controversies have led to a mountain of mechanistic data to improve the understanding of molecular and cellular effects related to phenotypic changes. These data provide fragments of information that have yet to be combined and used effectively to improve modeling, reduce uncertainties, and update radiation protection approaches. This paper suggests a better consolidation of mechanistic research may serve to guide priority research and facilitate translation to risk assessment. An effective approach that may be implemented is the organization of data using the adverse outcome pathway (AOP) framework, a programme that has been launched by the Organization for Economic Cooperation and Development in the chemical toxicology field. The AOP concept has proved beneficial to human health and ecological toxicological fields, demonstrating possibilities for better linkages of mechanistic data to phenotypic effects. A similar approach may be beneficial to the field of radiation research. However, for this to work effectively, collaborative efforts are needed among the scientific communities in the area of AOP development and documentation. Studies will need to be evaluated, re-organized and integrated into AOPs. Here, details of the AOP approach and areas it could support in the radiation field are discussed. In addition, challenges are highlighted and steps to integration are outlined. Organizing studies in this manner will facilitate a better understanding of our current knowledge in the radiation field and help identify areas where more focused work can be undertaken. This will, in turn, allow for improved linkage of mechanistic data to human relevance and better support radiation risk assessments.
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Affiliation(s)
- Vinita Chauhan
- Environmental Health Science Research Bureau, Health Canada, Ottawa, ON, Canada
| | - Daniel Villeneuve
- U.S. Environmental Protection Agency, Center for Computational Toxicology and Exposure, Great Lakes Toxicology and Ecology Division, Duluth, MN 55804, USA
| | - Donald Cool
- Electric Power Research Institute, Charlotte, NC, US
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Wang W, Wu Y, Yuan J, Yang Q, Zhou Z. Video-based education improves the image quality of diagnostic percutaneous cerebral angiography among elderly patients. Transl Neurosci 2020; 11:356-362. [PMID: 33335775 PMCID: PMC7712275 DOI: 10.1515/tnsci-2020-0107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 03/19/2020] [Accepted: 04/06/2020] [Indexed: 11/21/2022] Open
Abstract
Objective Digital subtraction angiography (DSA) is considered the gold standard for cerebral vasculature observation and is increasingly applied among the elderly population. The aim of this study is to determine whether the use of a video-based education system can improve the image quality of percutaneous cerebral angiography. Method This study is a single-blinded prospective cohort trial. One hundred and sixty patients (≥65 years old) were enrolled in this study. Eighty patients were provided with video-based education as intervention. Eighty age-matched controls only received regular education. The DSA image quality was assessed between control and intervention groups. It was rated by two readers on a 5-point scale, independently. Results No differences were found between control and intervention groups in baseline characteristics (P > 0.05). The mean overall image quality was significantly higher in patients receiving video-based education than in controls (P < 0.05), and the same trends were found in the respective assessment of each artery (left and right carotid/vertebral artery; P < 0.05). Moreover, the operation time and radiation doses were quite comparable between the two groups (P > 0.05). Conclusions This study indicated that video-based education helps elderly patients to acquire improved DSA image quality. It encourages the application of this approach in practice.
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Affiliation(s)
- Wenbing Wang
- Department of Neurology, The First Affiliated Hospital, Yijishan Hospital of Wannan Medical College, Wuhu 241000, China
| | - Yongshun Wu
- Department of Radiology, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen 518000, China
| | - Jianpeng Yuan
- Department of Radiology, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen 518000, China
| | - Qian Yang
- Department of Neurology, The First Affiliated Hospital, Yijishan Hospital of Wannan Medical College, Wuhu 241000, China
| | - Zhiming Zhou
- Department of Neurology, The First Affiliated Hospital, Yijishan Hospital of Wannan Medical College, Wuhu 241000, China
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Koenig AM, Maas J, Viniol S, Etzel R, Fiebich M, Thomas RP, Mahnken AH. Scatter radiation reduction with a radiation-absorbing pad in interventional radiology examinations. Eur J Radiol 2020; 132:109245. [PMID: 33011604 DOI: 10.1016/j.ejrad.2020.109245] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 08/16/2020] [Accepted: 08/19/2020] [Indexed: 12/13/2022]
Abstract
PURPOSE Radiation-absorbing pads are an additional possibility to reduce scattered radiation at its source. The goal of this study is to investigate the efficacy of a new reusable radiation-absorbing pad at its origin in an experimental setup. MATERIAL AND METHODS All measurements were carried out using a clinical angiography system with a standardized fluoroscopy protocol, different C-arm angulations and an anthropomorphic torso phantom as a scattering body. An ionization chamber was used to measure the radiation exposure at five different heights of a simulated operator during a simulated transfemoral angiography intervention. Measurements were carried out with and without radiation-absorbing pads with lead equivalents of 0.25 and 0.5 mm placed onto the scattering body. For all measurements a mobile acrylic shield and an under-table lead curtain was used. RESULTS At all operator heights from 100 to 165 cm a significant radiation dose reduction of up to 80.6 % (p < 0.01) using the radiation-absorbing pad was measured, when compared to no radiation-absorbing pad. At the height of 165 cm the radiation-absorbing pad with a lead equivalence of 0.5 mm showed a significant radiation dose reduction (51.4 %, p < 0.01) in comparison to a lead equivalence of 0.25 mm. CONCLUSION The addition of a radiation-absorbing pad to the standard protection means results in a significant dose reduction for the operator, particularly for upper body parts.
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Affiliation(s)
- A M Koenig
- Philipps-University of Marburg, Clinic of Diagnostic and Interventional Radiology, University Hospital Marburg, Germany.
| | - J Maas
- Philipps-University of Marburg, Clinic of Diagnostic and Interventional Radiology, University Hospital Marburg, Germany
| | - S Viniol
- Philipps-University of Marburg, Clinic of Diagnostic and Interventional Radiology, University Hospital Marburg, Germany
| | - R Etzel
- Mittelhessen University of Applied Sciences, Institute of Medical Physics and Radiation Protection, Giessen, Germany
| | - M Fiebich
- Philipps-University of Marburg, Clinic of Diagnostic and Interventional Radiology, University Hospital Marburg, Germany; Mittelhessen University of Applied Sciences, Institute of Medical Physics and Radiation Protection, Giessen, Germany
| | - R P Thomas
- Philipps-University of Marburg, Clinic of Diagnostic and Interventional Radiology, University Hospital Marburg, Germany
| | - A H Mahnken
- Philipps-University of Marburg, Clinic of Diagnostic and Interventional Radiology, University Hospital Marburg, Germany
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Manzo BO, Gómez F, Figueroa A, Sánchez HM, Leal M, Emiliani E, Sánchez FJ, Angerri O. A New Simplified Biplanar (0-90°) Fluoroscopic Puncture Technique for Percutaneous Nephrolithotomy. Reducing Fluoroscopy Without Ultrasound. Initial Experience and Outcomes. Urology 2020; 140:165-170. [DOI: 10.1016/j.urology.2020.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 02/25/2020] [Accepted: 03/04/2020] [Indexed: 10/24/2022]
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Dehairs M, Marshall NW, Bosmans H, Leghissa M. Radiation protection of operators and patients in a hybrid Angio-MR suite. Phys Med 2020; 74:143-154. [PMID: 32473413 DOI: 10.1016/j.ejmp.2020.04.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 04/22/2020] [Accepted: 04/28/2020] [Indexed: 11/30/2022] Open
Abstract
This work investigates the patient eye lens dose and x-ray scatter to the operator expected for a proposed hybrid Angio-MR concept. Two geometries were simulated for comparative assessment: a standard C-arm device for neuro-angiography applications and an innovative hybrid Angio-MR system concept, proposed by Siemens Healthineers. The latter concept is based on an over-couch x-ray tube and a detector inside an MRI system, with the aim of allowing combined, simultaneous MRI and x-ray imaging for procedures such as neurovascular interventions (including x-ray fluoroscopy and angiography imaging, 3D imaging, diffusion, and perfusion). To calculate the scattered radiation dose to the physician, Monte Carlo simulations were performed. Dose estimates of simplified models of the brain and eyes of both the patient and the physician and of the physician's torso and legs have been calculated. A number of parameters were varied in the simulation including x-ray spectrum, field of view (FOV), x-ray tube angulation, presence of shielding material and position of the physician. Additionally, 3D dose distributions were calculated in the vertical and horizontal planes in both setups. The patient eye lens dose was also calculated using a detailed voxel phantom and measured by means of thermoluminescent dosimeters (TLDs) to obtain a more accurate estimate. Assuming the same number of x-rays and the same size of the irradiated area on the patient's head, the results show a significant decrease in the scattered radiation to the physician for the Angio-MR system, while large increases, depending on setup, are expected to patient eye lens dose.
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Affiliation(s)
- M Dehairs
- UZ Gasthuisberg, Department of Radiology, Herestraat 49, 3000 Leuven, Belgium.
| | - N W Marshall
- UZ Gasthuisberg, Department of Radiology, Herestraat 49, 3000 Leuven, Belgium
| | - H Bosmans
- UZ Gasthuisberg, Department of Radiology, Herestraat 49, 3000 Leuven, Belgium; Medical Imaging Research Centre, Medical Physics and Quality Assessment, Katholieke Universiteit Leuven, 3000 Leuven, Belgium
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31
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Vergara-Garcia D, Gomez-Paz S, Robinson TM, Moore J, Ogilvy CS, Thomas AJ. Transition to Radial Approach for Neurovascular Procedures is Safe and Convenient: Characterization of a Learning Experience. Oper Neurosurg (Hagerstown) 2020; 19:489-494. [DOI: 10.1093/ons/opaa133] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 03/18/2020] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND
The transradial access for endovascular procedures has become a popular access point of preference for both patients and for many neuro-endovascular practitioners.
OBJECTIVE
To describe a single-center experience on the transition to a radial-first approach for neurovascular procedures, focused on diagnostic angiographies, and to compare the differences in terms of length of procedure within the first 5 mo of its execution.
METHODS
We performed a retrospective review of a prospective maintained cerebrovascular registry at an academic institution within the United States, to identify the expected adoption curve required to transition to a transradial route first approach focused mainly on diagnostic procedures. The 5 mo of experience were divided into 4 quartiles evenly distributed in time. The primary outcome was the total length of procedure. Secondary outcomes were access failure, radiation dose, the usefulness of ultrasound assistance and complications.
RESULTS
A total of 121 transradial procedures were performed: 113 diagnostic angiographies (93%) and 8 therapeutic interventions (7%). We identified 6 access failures (5%) and 1 complication (1%). The mean length for diagnostic angiographies was 24 ± 10 min, and for therapeutic procedures was 58 ± 19 min. A multivariate regression analysis demonstrated a significant decrease in the total length of procedures after the first quartile.
CONCLUSION
The transradial route shows to be a safe and convenient approach. The total length of procedure starts decreasing as providers gain experience and become more confident with this route, as seen in our 5-mo experience.
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Affiliation(s)
| | | | - Timothy M Robinson
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Justin Moore
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Christopher S Ogilvy
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Ajith J Thomas
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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Klein LW, Goldstein JA, Haines D, Chambers C, Mehran R, Kort S, Valentine CM, Cox D. SCAI Multi-Society Position Statement on Occupational Health Hazards of the Catheterization Laboratory: Shifting the Paradigm for Healthcare Workers' Protection. J Am Coll Cardiol 2020; 75:1718-1724. [PMID: 32273037 DOI: 10.1016/j.jacc.2020.02.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Kirkwood ML, Klein A, Guild J, Arbique G, Xi Y, Tsai S, Ramanan B, Timaran C. Novel modification to leaded eyewear results in significant operator eye radiation dose reduction. J Vasc Surg 2020; 72:2139-2144. [PMID: 32276011 DOI: 10.1016/j.jvs.2020.02.049] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 02/28/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Ocular radiation exposure from fluoroscopically guided interventions (FGIs) can cause cataracts. Standard lead eyewear may not significantly reduce eye radiation dose as the majority of scattered radiation penetrates the operator's eye obliquely. Our aim was to evaluate the efficacy of standard leaded eyewear and a customized eyewear design in lowering eye radiation dose to vascular surgeons. METHODS The attenuating efficacy of three forms of leaded eyewear (standard eyewear, eyewear with built-in leaded side shields, and our modified eyewear) was tested in both a simulated setting and clinical practice. The modified design consisted of safety eyewear with 0.75 mm of added lead shielding attached to the lateral and inferior borders of the eyewear frame to attenuate oblique radiation. We performed simulated experiments using an anthropomorphic head phantom (ATOM model 701; CIRS, Norfolk, Va) positioned to represent a primary operator performing right femoral access. Optically stimulated, luminescent nanoDot detectors (Landauer, Glenwood, Ill) were placed inside the phantom's ocular spaces and at the surface of the left eye within and outside the leaded glasses to measure the eye radiation dose reduction provided by each eyewear type. All three eyewear types were also tested during clinical FGIs by placing nanoDots below the operator's left eye, inside and outside of the eyewear coverage. Means and standard errors were calculated using a pooled linear mixed model with repeated measurements. RESULTS This prospective, single-center study included 60 FGIs, 30 with traditional eyewear and 30 with our modified design. There was no significant eye radiation dose reduction (P > .05) with the standard eyewear or leaded side shield eyewear in both the simulated and clinical settings. In the simulated environment, our modified design resulted in an 86% radiation dose reduction to the surface of the left eye and an 80% reduction in left lens radiation dose (P < .0001). In the clinical FGIs, the modified eyewear led to a 62% left ocular radiation dose reduction (P < .0001). CONCLUSIONS Standard lead-equivalent glasses are ineffective at reducing ocular radiation dose during FGIs. Eyewear modification with lateral and inferior lead shielding molded to the operator's face significantly decreases radiation exposure to the eye closest to the X-ray source.
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Affiliation(s)
- Melissa L Kirkwood
- Division of Vascular and Endovascular Surgery, Department of Surgery, UT Southwestern Medical Center, Dallas, Tex.
| | - Andrea Klein
- Division of Vascular and Endovascular Surgery, Department of Surgery, UT Southwestern Medical Center, Dallas, Tex
| | - Jeffrey Guild
- Division of Medical Physics, Department of Radiology, UT Southwestern Medical Center, Dallas, Tex
| | - Gary Arbique
- Division of Medical Physics, Department of Radiology, UT Southwestern Medical Center, Dallas, Tex
| | - Yin Xi
- Division of Medical Physics, Department of Radiology, UT Southwestern Medical Center, Dallas, Tex
| | - Shirling Tsai
- Division of Vascular and Endovascular Surgery, Department of Surgery, UT Southwestern Medical Center, Dallas, Tex
| | - Bala Ramanan
- Division of Vascular and Endovascular Surgery, Department of Surgery, UT Southwestern Medical Center, Dallas, Tex
| | - Carlos Timaran
- Division of Vascular and Endovascular Surgery, Department of Surgery, UT Southwestern Medical Center, Dallas, Tex
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Radiation exposure in the treatment of pediatric supracondylar humerus fractures. Arch Orthop Trauma Surg 2020; 140:449-455. [PMID: 31392407 DOI: 10.1007/s00402-019-03251-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Indexed: 02/09/2023]
Abstract
PURPOSE To determine the factors that influence radiation exposure during repair of supracondylar humerus fractures. METHODS Medical records of almost 200 children with supracondylar fractures were retrospectively analyzed for variables correlated with fluoroscopy time and radiation dose as measures of radiation exposure. RESULTS There was no statistically significant difference in fluoroscopy time (27 vs. 22 s p = 0.345) or direct radiation dose (0.394 vs. 0.318 mSv p = 0.290) between uniplanar and biplanar C-arm use. No statistically significant differences in fluoroscopy time or radiation dose were found for surgical technique, comorbid ipsilateral fractures, preoperative neurovascular compromise, or resident participation. There was a significant 8.3 s increase in fluoroscopy time (p = 0.022) and 0.249 mSv increase in radiation dose (p = 0.020) as the fracture type increased from II to III. An increase in one pin during CRPP resulted in a statistically significant 10.4 s increase in fluoroscopy time and a 0.205 mSv increase in radiation dose. There were significant differences between the physician with the lowest fluoroscopy time and radiation dose compared with the physicians with the two highest values for both fluoroscopy time and radiation dose (p < 0.01). CONCLUSIONS We found no significant difference in direct radiation exposure or fluoroscopy time when comparing biplanar to uniplanar C-arm use, resident participation, preoperative neurovascular compromise, or for comorbid ipsilateral fractures. Both outcomes increased significantly as fracture type increased from II to III and as the number of pins used during CRPP increased. Both outcomes were significantly different between the surgeons performing CRPP.
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Klein LW, Goldstein JA, Haines D, Chambers C, Mehran R, Kort S, Valentine CM, Cox D. SCAI multi‐society position statement on occupational health hazards of the catheterization laboratory: Shifting the paradigm for Healthcare Workers' Protection. Catheter Cardiovasc Interv 2020; 95:1327-1333. [DOI: 10.1002/ccd.28579] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 10/26/2019] [Indexed: 11/08/2022]
Affiliation(s)
- Lloyd W. Klein
- University of California, San Francisco San Francisco California
| | | | - David Haines
- William Beaumont School of Medicine Royal Oak Michigan
| | | | | | | | | | - David Cox
- Brookwood Baptist Health Birmingham Alabama
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Sirufo MM, Ginaldi L, De Martinis M. Nailfold Capillaroscopic Findings in an Orthopedic Surgeon: Reversible Abnormalities after the Cessation of Radiation Exposure. Radiat Res 2019; 193:236-240. [PMID: 31877253 DOI: 10.1667/rr15435.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Interventional fluoroscopy is a leading source of occupational ionizing radiation exposure for medical personnel. For example, orthopedic surgeons represent one occupation where the risk of exposure is large. This occupational hazard is the result of a cumulative dose of radiation over time. Adverse health effects induced by low-dose radiation exposure can arise from daily procedures performed over an entire career. Many of the radiation-induced effects that may develop are transient erythema, permanent epilation, dry desquamation, dermal necrosis and telangiectasia; these effects have occurred on the skin of fingers of interventionalists. Nailfold videocapillaroscopy (NVC) is a non-invasive technique useful for early detection of radiation-induced effects on microcirculation of fingernails. Here we report on a case of an orthopedic surgeon exposed to radiation for 30 years during his professional career. He performed NVC before and after the end of his professional career, and regression of the microcirculatory abnormalities were documented after cessation of radiation exposure. To our knowledge, this is the first published work in which the regression of chronic low-dose radiation-induced alterations of finger microvessels have been described and documented.
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Affiliation(s)
- Maria Maddalena Sirufo
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy.,Department of Allergology and Clinical Immunology Unit AUSL 04, Teramo, Italy
| | - Lia Ginaldi
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy.,Department of Allergology and Clinical Immunology Unit AUSL 04, Teramo, Italy
| | - Massimo De Martinis
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy.,Department of Allergology and Clinical Immunology Unit AUSL 04, Teramo, Italy
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Ngetu L, Marais W, Rose A, Rae WI. Ophthalmic manifestations of ionising radiation among interventionalists. AFRICAN VISION AND EYE HEALTH 2019. [DOI: 10.4102/aveh.v78i1.480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Background: Ionising radiation (IR) is an occupational hazard for interventionalists. Dry eye syndrome may develop. There may be damage to the corneal epithelium, causing irritation and ulceration. Radiation-induced cataracts commonly develop in the posterior sub-capsular (PSC) region of the lens and are more common in the left eye.Aim: The aim of this study was to describe the ophthalmological findings in South African interventionalists occupationally exposed to IR.Setting: This study was conducted in South Africa.Methods: A prospective cross-sectional study was conducted. Interventional radiologists (25), adult cardiologists (42) and paediatric cardiologists (31) were recruited at conferences and included in the study. Convenience sampling was used. Participants completed a survey that collected data on their demographics, their cataract risk factors and co-morbid diseases, their occupational history, their radiation safety practices and their training in occupational history. Participants’ eyes were examined using a slit lamp after dilation of the eyes. Ethics clearance was obtained and each participant gave informed consent. A descriptive analysis was done.Results: The median age of the 98 interventionalists screened was 43.5 years. They worked with radiation for a median of 7.5 years. Cataracts occurred in the left eye of 17 (17.3%) participants and in the right eye of nine (9.2%). There were five (5.1%) PSC cataracts in the left eye and one (1%) in the right eye. The vitreous was abnormal in 19.4% of participants. The tear break-up time was abnormal in 48% of participants.Conclusion: Ionising radiation is an occupational hazard posing a risk to interventionalists’ eyes. They are at increased risk of cataracts and dry eye syndrome, which can affect their occupational performance and quality of life. Education can positively influence the radiation safety practices of interventionalists that could reduce the detrimental effects of IR on their eyes.
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Kurtz MP. Fluoroless or fluoro less. J Pediatr Urol 2019; 15:591-592. [PMID: 31494043 DOI: 10.1016/j.jpurol.2019.07.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 07/09/2019] [Indexed: 11/19/2022]
Affiliation(s)
- Michael P Kurtz
- Boston Children's Hospital, Department of Urology, 300 Longwood Avenue, Hunnewell 3, Boston, MA, 02115, USA.
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Koenig AM, Etzel R, Greger W, Viniol S, Fiebich M, Thomas RP, Mahnken AH. Protective Efficacy of Different Ocular Radiation Protection Devices: A Phantom Study. Cardiovasc Intervent Radiol 2019; 43:127-134. [PMID: 31489475 DOI: 10.1007/s00270-019-02319-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 08/19/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE The aim of this study was to investigate the efficacy of different designs and types of ocular radiation protection devices depending on simulated varied body heights in a phantom-simulated thoracic intervention. MATERIALS AND METHODS A clinical angiography system with a standardized fluoroscopy protocol with an anthropomorphic chest phantom as a scattering object and optically stimulated luminescence dosimeters for measuring radiation dose were used. The dosimeters were placed at the position of eyes of an anthropomorphic head phantom simulating the examiner. The head phantom was placed on a height-adjustable stand simulating the height of the examiner from 160 to 200 cm with 10 cm increments. The dose values were then measured with no radiation protection, a weightless-like radiation protection garment, radiation protection glasses and visors. RESULTS The average dose reduction using radiation protection devices varied between 57.7 and 83.4% (p < 0.05) in comparison with no radiation protection. Some radiation protection glasses and visors showed a significant dose reduction for the eye lenses when the height of the examiner increased. The right eye was partially less protected, especially if the distances between the simulated examiner's head and the scatter object were small. CONCLUSION All the investigated protection devices showed a significant reduction in radiation exposure to the simulated examiner. For some devices, the radiation dose increased with decreasing distance to the scattering object, especially for the right eye lens.
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Affiliation(s)
- A M Koenig
- Clinic of Diagnostic and Interventional Radiology, Philipps-University of Marburg, Baldingerstrasse 1, 35043, Marburg, Germany.
| | - R Etzel
- Clinic of Diagnostic and Interventional Radiology, Philipps-University of Marburg, Baldingerstrasse 1, 35043, Marburg, Germany.,Institute of Medical Physics and Radiation Protection, Mittelhessen University of Applied Sciences, Giessen, Germany
| | - W Greger
- Institute of Medical Physics and Radiation Protection, Mittelhessen University of Applied Sciences, Giessen, Germany
| | - S Viniol
- Clinic of Diagnostic and Interventional Radiology, Philipps-University of Marburg, Baldingerstrasse 1, 35043, Marburg, Germany
| | - M Fiebich
- Institute of Medical Physics and Radiation Protection, Mittelhessen University of Applied Sciences, Giessen, Germany
| | - R P Thomas
- Clinic of Diagnostic and Interventional Radiology, Philipps-University of Marburg, Baldingerstrasse 1, 35043, Marburg, Germany
| | - A H Mahnken
- Clinic of Diagnostic and Interventional Radiology, Philipps-University of Marburg, Baldingerstrasse 1, 35043, Marburg, Germany
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Austin K, Schoenberger H, Saha S. Special situations: Performance of endoscopy while pregnant. TECHNIQUES IN GASTROINTESTINAL ENDOSCOPY 2019. [DOI: 10.1016/j.tgie.2019.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Comparison of Nonimage- and Fluoroscopy-Guided Interlaminar Epidural Block: A Matched Paired Analysis in the Same Individuals. Pain Res Manag 2019; 2019:7513617. [PMID: 31065303 PMCID: PMC6466840 DOI: 10.1155/2019/7513617] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 12/11/2018] [Indexed: 12/21/2022]
Abstract
Background Although fluoroscopic guidance is recommended highly for more accurate lumbar interlaminar epidural steroid injection (L-ESI), many physicians still use a nonimage-guided approach for L-ESIs. However, because of its associated risk of radiation and increased medical expense, the cost-effectiveness and safety of fluoroscopy-guided ESI have been called into question. The goal of this retrospective matched paired analysis in the same individuals was to assess the effectiveness and prevalence of complications of nonimage-guided L-ESI compared to those of fluoroscopy-guided L-ESI. Methods. Between 2015 and 2016, 94 patients who received both nonimage- and fluoroscopy-guided L-ESIs were analyzed retrospectively. The changes of the numeric rating scale (NRS) in pain intensity and functional outcome and the differences in the number of complications between blind and fluoroscopy-guided L-ESIs in the same individuals were evaluated by a matched paired analysis. Results Of the 94 patients, the differences in NRS before and after the procedure were 1.29 (95% confidence interval (CI) = 0.94–1.65) for the nonimage-guided group and 1.64 (95% CI = 1.28–2.01) for the fluoroscopy-guided group (p=0.16). More subjective functional improvement was observed in fluoroscopy-guided L-ESI (57, 60.6%) than in nonimage-guided L-ESI (47, 50.0%) without statistical significance (p=0.16). Nine (9.6%) patients in the nonimage-guided group experienced complications related to the procedure overall compared to 4 (4.3%) in the fluoroscopy-guided group (p=0.27). Conclusions In this study, both blind and image-guided L-ESI techniques included similar extents of postprocedural outcomes and complications. Physicians should consider the risks associated with the two different techniques overall and develop ways to individualize the procedure to decrease the risk of complications and improve the positive outcomes of lumbar epidural steroid injections.
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Etzel R, König AM, Keil B, Fiebich M, Mahnken AH. Effectiveness of a new radiation protection system in the interventional radiology setting. Eur J Radiol 2018; 106:56-61. [PMID: 30150051 DOI: 10.1016/j.ejrad.2018.07.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 05/30/2018] [Accepted: 07/07/2018] [Indexed: 01/19/2023]
Abstract
OBJECTIVES The goal of this study was to examine a new weightless-like radiation protection garment regarding its radiation protection efficacy and to compare it to a conventional two-piece apron suit plus thyroid collar and standard ancillary shields. MATERIAL AND METHODS All measurements were carried out using a clinical angiography system with a standardized fluoroscopy protocol for different C-arm angulations. An anthropomorphic torso phantom served as a scattering body. In addition, an ionization chamber was used to measure the radiation exposure on five different representative heights and at two different positions of an examiner during a typical fluoroscopic-guided intervention. RESULTS The new weightless-like radiation protection garment and the conventional protection concept showed a mean dose reduction of 98.1% (p < 0.01) and 90.1% (p < 0.01) when compared to no shielding, respectively. By adding ancillary shields to both systems, an average reduction of 99.0% (p < 0.01) and 98.2% (p < 0.01) was found. In addition, the efficacy of both systems varied depending on the height, the C-arm angulation and position of the examiner. CONCLUSION Combined with ancillary shields as an overall protection system, the recently introduced weightless-like radiation protection garment showed a significant better radiation protection efficacy when compared to conventional radiation protection measures.
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Affiliation(s)
- Robin Etzel
- Technische Hochschule Mittelhessen (THM) - University of Applied Sciences, Department of Life Science Engineering, Institute of Medical Physics and Radiation Protection, Wiesenstrasse 14, 35390 Giessen, Germany; Philipps-University of Marburg, Clinic of Diagnostic and Interventional Radiology, Baldingerstrasse, 35043 Marburg, Germany.
| | - Alexander M König
- Philipps-University of Marburg, Clinic of Diagnostic and Interventional Radiology, Baldingerstrasse, 35043 Marburg, Germany.
| | - Boris Keil
- Technische Hochschule Mittelhessen (THM) - University of Applied Sciences, Department of Life Science Engineering, Institute of Medical Physics and Radiation Protection, Wiesenstrasse 14, 35390 Giessen, Germany.
| | - Martin Fiebich
- Technische Hochschule Mittelhessen (THM) - University of Applied Sciences, Department of Life Science Engineering, Institute of Medical Physics and Radiation Protection, Wiesenstrasse 14, 35390 Giessen, Germany.
| | - Andreas H Mahnken
- Philipps-University of Marburg, Clinic of Diagnostic and Interventional Radiology, Baldingerstrasse, 35043 Marburg, Germany.
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Sailer AM, Vergoossen L, Paulis L, van Zwam WH, Das M, Wildberger JE, Jeukens CRLPN. Personalized Feedback on Staff Dose in Fluoroscopy-Guided Interventions: A New Era in Radiation Dose Monitoring. Cardiovasc Intervent Radiol 2017; 40:1756-1762. [PMID: 28500459 PMCID: PMC5651709 DOI: 10.1007/s00270-017-1690-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Accepted: 05/03/2017] [Indexed: 10/31/2022]
Abstract
PURPOSE Radiation safety and protection are a key component of fluoroscopy-guided interventions. We hypothesize that providing weekly personal dose feedback will increase radiation awareness and ultimately will lead to optimized behavior. Therefore, we designed and implemented a personalized feedback of procedure and personal doses for medical staff involved in fluoroscopy-guided interventions. MATERIALS AND METHODS Medical staff (physicians and technicians, n = 27) involved in fluoroscopy-guided interventions were equipped with electronic personal dose meters (PDMs). Procedure dose data including the dose area product and effective doses from PDMs were prospectively monitored for each consecutive procedure over an 8-month period (n = 1082). A personalized feedback form was designed displaying for each staff individually the personal dose per procedure, as well as relative and cumulative doses. This study consisted of two phases: (1) 1-5th months: Staff did not receive feedback (n = 701) and (2) 6-8th months: Staff received weekly individual dose feedback (n = 381). An anonymous evaluation was performed on the feedback and occupational dose. RESULTS Personalized feedback was scored valuable by 76% of the staff and increased radiation dose awareness for 71%. 57 and 52% reported an increased feeling of occupational safety and changing their behavior because of personalized feedback, respectively. For technicians, the normalized dose was significantly lower in the feedback phase compared to the prefeedback phase: [median (IQR) normalized dose (phase 1) 0.12 (0.04-0.50) µSv/Gy cm2 versus (phase 2) 0.08 (0.02-0.24) µSv/Gy cm2, p = 0.002]. CONCLUSION Personalized dose feedback increases radiation awareness and safety and can be provided to staff involved in fluoroscopy-guided interventions.
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Affiliation(s)
- Anna M. Sailer
- Department of Radiology, Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands
- Department of Radiology, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94303 USA
| | - Laura Vergoossen
- Department of Radiology, Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands
| | - Leonie Paulis
- Department of Radiology, Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands
| | - Willem H. van Zwam
- Department of Radiology, Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands
| | - Marco Das
- Department of Radiology, Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands
- CARIM School of Cardiovascular Diseases, Maastricht University Medical Centre, 6229 HX Maastricht, The Netherlands
| | - Joachim E. Wildberger
- Department of Radiology, Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands
- CARIM School of Cardiovascular Diseases, Maastricht University Medical Centre, 6229 HX Maastricht, The Netherlands
| | - Cécile R. L. P. N. Jeukens
- Department of Radiology, Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands
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